Al Makassed Hospital in East Jerusalem is the leading provider of neonatology expertise in Palestine, however its service is being undermined by a confluence of political and economic forces related to the ongoing occupation.

The neonatology department at Al Makassed is a tertiary referral unit, meaning that it exclusively deals with cases of high-risk obstetric complications that have been referred to it from other hospitals throughout Palestine. Hatem Khamash, the hospital’s head of neonatology, says that his department is often indirectly restricted from doing all the work it could be doing by the practices and policies of the occupation. In particular, the restrictions on movement in and out of Gaza produce a number of follow-on issues for the department.

The children born at Al Makassed often require prolonged periods of intensive care, particularly if they have been born prematurely or with complications. If the mothers of these children come from Gaza, they are usually obliged to return home without their children.This is primarily because their permits to enter Jerusalem only last for the extent of their own medical concerns, but also because it is too expensive to stay in Jerusalem while their child recovers.

Al Makassed has attempted to provide accommodation for family members of its Gaza patients by fitting out shipping containers with bunk beds on the roof of the hospital. However, as it assumes all the costs of their stay, the hospital cannot afford to accommodate these people for more than a few days at a time.

Consequently, after a mother has been discharged, she may stay for only a few days before returning to Gaza. Once this occurs, the process of her visiting her child, or bringing them home, becomes far more difficult. This means that babies are left in the hospital’s sole care for months at a time with no familial contact.

The first concern arising from this situation is the physical separation between the child and its mother. Khamash notes that it is standard practice in modern hospitals around the world for babies to be kept with their mothers in the first months of their life, even if they require intensive care. This practice reflects research that suggests sensory contact between mother and child in the first weeks or months after birth increases brain development and decreases the risks of a number of neurological and behavioural issues.

Of course, on the mother’s side, separation from their child after birth can be highly traumatic. Earlier this year, AFP reported on a mother from Gaza, Jumana Daoud, who had been separated from her newborn daughter Maryam for six months after giving birth to her at Al Makassed. Daoud was forced to return to Gaza and was unable to obtain a permit to visit her daughter at all while she recovered. Khamash added that Maryan had in fact finished her treatment a full two months before her mother was eventually permitted to retrieve her, but that delays in the processing of permits meant that she was needlessly forced to remain at the hospital during that time.

Khamash says that it was only after the UK organization Medical Aid for Palestinians investigated the case and attracted media interest to it that Israeli authorities granted Daoud a permit to retrieve her daughter from the hospital. Israeli authorities stated their Palestinian counterparts had failed to file the permit request.

In its monthly reports on Gaza medical access, the World Health Organization reported that, in January, the rate of denial or delay of permits for the companions of patients to leave Gaza was 61.4%, while in December it was 65% and in November 57.3%.

These figures are particularly important for Khamash because they represent actual delays in his department’s provision of care to new patients. Khamash says Israeli authorities do not allow for the babies to travel to Gaza unless a family member accompanies them and so, until a companion permit is granted, the hospital is forced to continue wasting unnecessary beds and resources.

Khamash recounts, “At one time I had four or five babies that I wanted to transfer. They had completed the treatment – they had nothing to do… I can’t accept new babies. I can’t do anything until these babies go back to Gaza.”

Khamash says the minimum time it takes to get approval for a baby to be accompanied back to Gaza is two to three weeks, but that, in most cases, it takes one to two months. Furthermore, when a companion is approved, it is almost never the child’s mother or father because they are usually less than 35 years old and therefore deemed a security risk.

The limitations on the number of beds and other resources the hospital can deploy means that it is forced to turn away at-risk mothers. Khamash says that no other hospital in Palestine can offer the level of specialized care that Al Makassed offers in its neonatology department and so having to turn these at-risk women away is dangerous.

Of course, many of these problems would be averted if better services were available throughout Palestine. Gaza, for instance, has only one specialist neonatologist across twelve hospitals. To counteract this, Al Makassed has begun a program to bring doctors in for three-month residencies to transfer some of the skills and expertise of Khamash’s department back to Gaza. A large problem with this, however, says Khamash, is that most of the junior doctors that would be ideal for the program are automatically denied permits because they are under 35.

Ahmed Jebara, a more senior doctor from Gaza who has been granted a permit to participate in the program, suggested that a lack of expertise was only one facet of the problem. Jebara said that there was not enough equipment or nurses in Gaza’s hospitals. The newborns of Gaza are not receiving all the care that babies with complicated births require. Hospitals in Gaza also have to cope with electricity shortages due to the ongoing power crisis, which normally sees the Strip on a schedule of eight hours on and eight hours off. Hospitals use generators, but these are less reliable and expensive to run on fuel.

Much of the equipment being used in Gaza’s hospitals is also donated second-hand, meaning that breakdowns are frequent, while Israel’s blockade of the Strip makes the importation of repair parts extremely difficult. For the at risk mothers and children of Gaza, the bureaucratic delays of people and equipment moving in and out of the Strip hold very real dangers.